New York's Medicaid program incorrectly paid out nearly $1 billion to providers over a four year period, according to two audits released Tuesday by state Comptroller Tom DiNapoli's office.
The audits found the improper payments were made for services that included ordering, prescribing, referring and attending providers who are no longer enrolled in the Medicaid program at the time of the service.
At the same time, improper payments of $5.8 million were used for services for providers who were excluded from participating in the Medicaid program due to previous improper behavior or wrongdoing. Changes to the program known as eMedNY were made in February 2018 that had led to a notable drop in the number of improper payments, the audit found.
Nevertheless, from March 2018 to December 2019, the comptroller's office still found $45.6 million in payments for more than 135,000 services to providers who are not eligible.
“Medicaid is a critically important program, but its payment system is rife with errors,” DiNapoli said. “My auditors found the system was allowing payments on claims involving providers who were not certified to treat Medicaid patients. This not only costs taxpayers, but also allows providers who should be excluded, and may be unqualified, to treat patients. DOH must improve its efforts to fix the shortcomings with its billing system.”
The comptroller's office recommended the state Department of Health review payments for Medicaid claims involving inactive providers, strengthen controls to prevent improper payments and update guidelines to clarifying billing rules.